Myosteatosis predicts postoperative complications and long-term survival in robotic gastrectomy for gastric cancer: A propensity score analysis

Pingan Ding; Jiaxiang Wu; Haotian Wu; Tongkun Li; Jiaxuan Yang; Li Yang; Honghai Guo; Yuan Tian; Peigang Yang; Lingjiao Meng; Qun Zhao

doi:10.1111/eci.14201

Myosteatosis predicts postoperative complications and long-term survival in robotic gastrectomy for gastric cancer: A propensity score analysis

Eur J Clin Invest. 2024 Mar 27:e14201. doi: 10.1111/eci.14201. Online ahead of print.

Authors

Pingan Ding^{1

2

3}, Jiaxiang Wu^{1

2

3}, Haotian Wu^{1

2

3}, Tongkun Li^{1

2

3}, Jiaxuan Yang^{1

2

3}, Li Yang^{2

3

4}, Honghai Guo^{1

2

3}, Yuan Tian^{1

2

3}, Peigang Yang^{1

2

3}, Lingjiao Meng^{2

3

5}, Qun Zhao^{1

2

3}

Affiliations

¹ The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
² Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China.
³ Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China.
⁴ The Department of CT/MRI, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
⁵ Research Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

PMID: 38533747
DOI: 10.1111/eci.14201

Abstract

Background: Robotic gastrectomy is increasingly utilized for gastric cancer, but high morbidity remains a concern. Myosteatosis or low skeletal muscle density reflecting fatty infiltration, associates with complications after other cancer surgeries but has not been evaluated for robotic gastrectomy.

Methods: This retrospective study analysed 381 patients undergoing robotic gastrectomy for gastric cancer from September 2019 to October 2022. Myosteatosis was quantified on preoperative computed tomography (CT) images at lumbar 3 (L3). Propensity score matching addressed potential confounding between myosteatosis and non-myosteatosis groups. Outcomes were postoperative complications, 30 days mortality, 30 days readmissions and survival.

Results: Myosteatosis was present in 33.6% of patients. Myosteatosis associated with increased overall (47.7% vs. 26.5%, p < 0.001) and severe complications (12.4% vs. 4.9%, p < 0.001). After matching, myosteatosis remained associated with increased overall complications, major complications, intensive care unit (ICU) transfer and readmission (all p < 0.05). Myosteatosis independently predicted overall [odds ratio (OR) = 2.86, 95% confidence interval (CI): 1.57-5.20, p = 0.001] and severe complications (OR = 4.81, 95% CI: 1.51-15.27, p = 0.008). Myosteatosis also associated with reduced overall (85.0% vs. 93.2%, p = 0.015) and disease-free survival (80.3% vs. 88.4%, p=0.029). On multivariate analysis, myosteatosis independently predicted poorer survival [hazard ratio (HR) = 2.83, 95% CI: 1.32-6.08, p=0.012] and disease-free survival (HR = 1.83, 95% CI: 1.01-3.30, p=0.032).

Conclusion: Preoperative CT-defined myosteatosis independently predicts increased postoperative complications and reduced long-term survival after robotic gastrectomy for gastric cancer. Assessing myosteatosis on staging CT could optimize preoperative risk stratification.

Keywords: Myosteatosis; gastric cancer; postoperative complications; propensity score matching; robotic surgery.